Who should provide health care?

Letters to the editor on health care providers

The article regarding Senate Bill 491 and autonomous practice for nurse practitioners (NPs) was very misleading (“Doctors should take lead on patient care,” Op-Ed, June 27).

Autonomous practice does not mean that NPs sever their connection with physicians, rather they provide vital health care services within their scope of practice, and make appropriate referrals of patients who need a different level and/or type of care.

Eighteen states and the District of Columbia already permit autonomous delivery of primary care services by NPs. None of these states has demonstrated any problems with patient safety or quality of care.

California’s restrictive regulations for NP practice are not evidence-based and have no patient-safety foundation. The California Medical Association and other physician groups that lead the opposition to SB 491 have no plan or ability to provide primary care to the soon-to-be-insured millions of Californians who will gain insurance through The Affordable Care Act.

In response to the article June 27 in the U-T by the San Diego County Medical Society president and the vice speaker of the California Medical Association, as an advanced practice registered nurse (APRN), a certified nurse-midwife/ women’s health nurse practitioner and SDSU nursing professor, I was very disturbed to see the article in the U-T concerning Senate Bill 491.

SB 491 does not allow for expansion of practice to do things outside education and training. It does allow for APRNs to practice to the fullest extent of their lawful education and training: NOT BEYOND! California APRN’s must abide by the California Board of Registered Nursing Scope of Practice Regulations, which already include primary care.

There are national certification exams for all APRNs. All hospital bylaws and most community clinics and private practices have national certification as a credentialing requirement for employment.

The use of “Allied Health Professional” as terminology for all professions other than MD’s is disconcerting. APRNs, optometrists and pharmacists are separate and distinct professions with their own credentials.

Lauren P. Hunter

La Jolla

Drs. Peters and Mazer, “speaking in the interest of our patients” call for modification of SB 491. They say that independent practice by nurse practitioners (NPs) is “unsafe for Californians,” citing a 2011 editorial by Lindbloom et al.

This never-published study actually was an analysis of a systematic review done by the well-known Cochrane Database of Systematic Reviews. Cochrane’s analysis looked at a very large, 30-year body of research surrounding NP care and concluded that appropriately trained nurses can produce as high quality care as primary care doctors and achieve as good health outcomes for patients. Lindbloom’s critique centered on the quality of the research, concluding, that it was “insufficient to make conclusions,” noting too few randomized trials and low numbers of participants.

In response to Lindbloom, those large studies have been done. For example, a 2010 Veterans Administration survey of 1,601,828 patients showed most of the primary care clinic patients preferred to see NPs as compared with MDs. A quote from the conclusions: “Besides clinical care, NPs focus on health promotion, disease prevention, health education, attentiveness, and counseling.”

Perhaps the doctors’ arguments are more about protection of their turf rather than the safety of Californians.

Patricia Quinn

USD Associate Clinical Prof.

SB 491 does not allow nurse practitioners expansion of practice beyond our education and training. It removes barriers that permit us to practice to the full extent of our education and training.

Almost half the states in U.S. permit nurse practitioners to practice without direct physician supervision.

The medical doctors do not want us to practice independently because they wish to take a cut of the reimbursement we are paid for our services. This is the real issue.